Ergots and Midrin for Migraines

Regrettably, like most medications, two common treatments for migraine carry risks for side effects: ergots and Midrin.

Ergots are a class of compounds, similar to triptans, that are technically known as 5-HT1B/1D agonists. That is, they block action by sitting on nerve receptors where natural biochemicals would otherwise reside. They are among the oldest treatments for migraine in the modern medicine cabinet. As such, they've been subject to long-term intensive studies.

The results of those studies suggest that some caution should be used when taking them. Though generally safe and effective, they are not as much so as more contemporary drugs such as Maxalt and Zomig (two types of triptan).

One form known as DHE (dihydroergotamine) comes in a nasal spray, which has the advantage of entering the blood stream quickly through the thin nasal membranes. But, like all ergots (Ergomar, Wigraine, Cafergot and more), it does have limitations and possible side effects.

Paradoxically, one of the drawbacks of all ergots is that they perform their intended purpose: to constrict blood vessels. But there are two potential problems with this. One is that they may perform it too well. Ergots can cause excessive constriction, which can produce harmful effects for those with heart or kidney conditions. The other potential problem, however, is more fundamental.

For decades the leading theory of the cause of migraines was that it resulted from dilation of blood vessels. The subsequent volume and pressure changes stimulate, so the theory goes, pain signals in nerve cells. But more recent research suggests that, though involved, the cause may be more primary. Still under investigation, with no definitive conclusions as yet, researchers now believe it's more likely to be due to genetic abnormalities in the nerve cells in the brain.

As a result, constricting the blood vessels may be only attacking a peripheral issue and the potential side effects may represent an unnecessary risk. Ergots tend to preferentially constrict blood vessels in the heart and the effects are more long lasting than triptans, for example.

Ergots are also more prone to causing nausea and vomiting, which is already one of the common symptoms of migraine. Triptans tend to be accompanied by compounds that help reduce nausea. They are particularly risky for pregnant women, since they can cause contraction of the uterus and hence miscarriages.

Midrin is another traditional treatment for migraines, but is also used for tension headaches. A combination of isometheptene (a blood vessel constrictor), dichloralphenazone (a mild sedative) and acetaminophen (a pain reliever), it too carries risks. Those with high blood pressure, glaucoma or kidney disease are particularly vulnerable. Side effects can include dizziness and skin rash.

Drugs like ergots and Midrin are termed abortive drugs, since they are designed to abort a migraine or headache at onset of the symptoms. As distinguished from so-called prophylactics which are used to prevent them. As such, they are most effective when taken early on in a migraine episode. When used by those who suffer mild migraines, they have been effective and may form part of a spectrum of treatments.

But, as with all medications, they should be taken under the care of a physician and patients should ask probing questions about risks and side effects.